Provider Demographics
NPI:1003482761
Name:MORRIS, WILLIE III
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:MORRIS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22205 PEACH TREE AVE
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-5157
Mailing Address - Country:US
Mailing Address - Phone:708-954-6010
Mailing Address - Fax:
Practice Address - Street 1:22205 PEACHTREE AVE
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411
Practice Address - Country:US
Practice Address - Phone:708-953-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver